I am writing to inform you that the ASA leadership has concluded that the interests of our medical specialty and patients are best served by continued strong opposition to the Senate reform bill, H.R. 3590, the “Patient Protection and Affordable Care Act,” and a “no” vote on the reconciliation bill. Based on the best available information, it appears quite clear that the reconciliation bill taking shape in Congress will not address the concerns of the physician community. ASA members are urged to contact their Member of Congress to urge a “no” vote on the reform initiative, regardless of the mechanisms by which the bills are considered.
The ASA remains strongly committed to meaningful health system reform that strengthens the delivery of medical care to Americans. Indeed, because of that commitment, the decision to urge a “no” comes with some reluctance, but no regret. The failure of Congress and the White House to address important concerns raised by the physician community has made any endorsement or support of the reform bills impossible. Simply put, Congress has given us a closed, flawed process to advance a flawed bill.
Despite the President and Congressional leaders’ previously stated commitments to transparency as part of the health system reform debate, the process leading up to final consideration of the reform bills has been anything but transparent. The historic nature of this reform effort and its potential to impact one-sixth of the nation’s economy demanded that clarity and transparency be the rule. Instead the public and vital healthcare stakeholders have been left confused and perplexed by each new turn in the reform process. As recent Congressional discussions and press reports have referenced a “shell” bill moving through the House Budget Committee or the consideration of “deemed” passage by the House of Representatives, the legitimacy of the process is rightly called into question. Instead of generating support for advancing change in health care, a flawed process has spawned irreversible public and physician community suspicion and anxiety regarding the reform effort.
The content of the emerging reform bills is similarly flawed. While a number of laudable insurance reform provisions have been advanced as part of the reform debate – many of which have near universal support including the support of ASA, those provisions are overshadowed by the many deeply troubling details of the Senate bill. In legislation and law, details matter and the details found in these bills do not reflect a commitment to America’s physicians. Indeed, given the nature of this debate, the U.S. Congress had an historic opportunity to affirm and strengthen the role of U.S. physicians – the world’s finest physicians. The opportunity was missed. Instead, an argument can be made that the viability of medical practice has been weakened as part of this reform effort and, as a consequence, our ability to deliver needed care to the sick and injured is threatened.
ASA believes that the bills currently under consideration advance multiple provisions that marginalize physicians. As an example, H.R. 3590 finances its reforms largely on the backs of the physician community. The lack of provisions to repeal the broken Medicare SGR formula – the funds for which were directed to other purposes during the reform debate – is exacerbated by multiple other provisions that could result in additional payment reductions for physicians under Medicare and in the commercial insurance marketplace over the next decade. Other provisions rely on Medicaid programs to cover the uninsured without adequate remedy to the widely recognized inadequacy of the financial underpinnings of this program. Still other language would establish an Independent Payment Advisory Board (IPAB) with sweeping powers to cut Medicare payments. And meanwhile, the so-called “non-discrimination” provisions seek to elevate paraprofessionals in the health care marketplace by prohibiting health plans from appropriately differentiating between physicians and those paraprofessionals. The hope that the reform effort would recognize physicians’ unique and indispensible role in the health care system appears to have come to naught in these flawed reform bills.
From the earliest days of the reform debate, ASA sought to be a constructive participant in a potentially historic effort to achieve enactment of a responsible health care reform initiative. We have sought every opportunity to work with lawmakers of both parties and have been consistent and clear about our requirements. Regrettably, the process to achieve responsible reform and the policies ultimately advanced have resulted in disappointment and a missed opportunity to make American health care better.
I am gratified by the active role anesthesiologists have played in this reform debate. Our leadership in the medical community in preventing any proliferation of Medicare rates through a public option and other issues has demonstrated the impact of the voice of anesthesiologists. And to that end we must remain vigilant and resolved. Please make your voice heard again by contacting your Member of Congress to urge a “no” vote on these reform bills.
Also please continue to monitor your email and the ASA website for additional communications as amendments are anticipated during Senate consideration of the reconciliation bill in the near future.
Alexander A. Hannenberg
President, American Society of Anesthesiologists